［摘要］目的：運用中醫時間醫學理論闡釋病毒性心肌炎患者室性早搏24 h的分佈規律，爲確定合理的給藥時間提供科學的依據。方法：240例病毒性心肌炎患者行24 h動態心電圖監測，運用中醫五臟主時節律等理論對患者室性早搏分佈的節律性變化進行研究。結果：病毒性心肌炎患者室性早搏普遍高發於寅、卯、辰、巳四個時辰，尤以卯時爲甚；酉、戌、亥三個時辰爲室性早搏發生的低谷時段。隨着年齡的增長，病毒性心肌炎患者室性早搏夜半時段的'發生頻度增加。不同證型的病毒性心肌炎患者其室性早搏發作的高峯時段不同。邪熱犯心證患者，室性早搏多高發於日中時段；陰虛火旺證患者，室性早搏多高發於白天，日中時段加重；心氣陽虛證患者，室性早搏多高發於平旦和夜半時段。結論：病毒性心肌炎患者室性早搏日分佈具有明顯的中醫病理節律，不同證型的室性早搏，其日分佈的節律亦不相同，可指導臨牀辨證施治。
［關鍵詞］晝夜節律; 心肌炎; 室性早搏複合徵
Study on pathological rhythm of traditional Chinese medicine about circadian distribution of premature ventricular contractions in 240 patients with viral myocarditis
ABSTRACT Objective: To explore the circadian distribution of premature ventricular contractions (PVCs) in patients with viral myocarditis (VM) according to the theory of chronomedicine in traditional Chinese medicine (TCM) in order to find out the scientific evidence for a reasonable administration time. Methods: Two hundred and forty patients with VM were enrolled and electrocardiograms were examined for all by Holter monitor. The circadian distribution of PVCs was evaluated according to the theory of chronomedicine of TCM about time periods corresponding to five zang viscera. Results: PVCs mostly happened in periods of 3∶005∶00, 5∶007∶00, 7∶009∶00 and 9∶0011∶00, in which 5∶007∶00 was the most serious time. Less PVCs happened in periods of 17∶0019∶00, 19∶0021∶00 and 21∶0023∶00. The frequency of PVCs in midnight also increased with aging. The time periods of the frequency peak of PVCs in patients with different syndromes were also different. In patients with syndrome of pathogenic heat invading heart (PHIH), the PVCs mostly appeared in midday. In patients with syndrome of flaring of fire due to yindeficiency (FFYD), the PVCs were most serious in daytime and aggravated at noon. And in patients with syndrome of insufficiency of heartqi and yang (IHQY), the PVCs mostly happened in early morning or midnight. Conclusion: There was a manifest regulation of the pathological circadian rhythm of PVCs in patients with VM. The circadian distributions of PVCs were variable in patients with different syndromes. Therefore the theory of chronomedicine of TCM may be used to guide the treatment based on syndrome differentiation.
KEY WORDS circadian rhythm; myocarditis; ventricular premature complexs
各種心律失常是病毒性心肌炎的主要表現，尤以室性早搏最爲常見。有報道指出：頻發室性早搏可使冠狀循環血流減少25%，腦循環血流減少25%，腎血流減少8%～10%。因此，抗心律失常是治療病毒性心肌炎的一個重要方面。但由於其潛在的致心律失常作用，致使其在臨牀的使用受到了一定的限制。採用中醫藥辨證治療病毒性心肌炎室性早搏，具有獨特的優勢，尤其是對於那些室性早搏集中分佈型的患者，辨時與辨證相結合的治療方法已成爲提高療效的重要途徑。